Nottingham Digestive Disease Centre and Biomedical Research Unit, Nottingham University Hospital NHS Trust, Nottingham, UK.
Neurogastroenterol Motil. 2012 Apr;24(4):318-e163. doi: 10.1111/j.1365-2982.2011.01863.x. Epub 2012 Jan 25.
Recurrent abdominal pain is reported by a third of patients with diverticulosis, particularly those with previous episodes of acute diverticulitis. The current understanding of the etiology of this pain is poor. Our aim was to assess visceral sensitivity in patients with diverticular disease and its association with markers of previous inflammation and neuropeptides.
Patients with asymptomatic and symptomatic diverticular disease underwent a flexible sigmoidoscopy and biopsy followed 5-10 days later by visceral sensitivity testing with barostat-mediated rectal distension. Inflammation was assessed by staining of serotonin (5HT) and CD3 positive cells. mRNA levels of tumor necrosis factor alpha (TNF α) and interleukin-6 (IL-6) were quantitated using RT-PCR. Neuropeptide expression was assessed from percentage area staining with substance P (SP) and mRNA levels of the neurokinin 1 & 2 receptors (NK1 & NK2), and galanin 1 receptor (GALR1).
Thirteen asymptomatic and 12 symptomatic patients were recruited. The symptomatic patients had a lower first reported threshold to pain (28.4 mmHg i.q.r 25.0-36.0) than the asymptomatic patients (47 mmHg i.q.r 36.0-52.5, P < 0.001). Symptomatic patients had a higher median overall pain rating for the stimuli than the asymptomatic patients (P < 0.02). Symptomatic patients had greater median relative expression of NK1 and TNF alpha mRNA compared with asymptomatic patients. There was a significant correlation between barostat VAS pain scores and NK 1 expression (Figure 4, r(2) 0.54, P < 0.02).
CONCLUSIONS & INFERENCES: Patients with symptomatic diverticular disease exhibit visceral hypersensitivity, and this may be mediated by ongoing low grade inflammation and upregulation of tachykinins.
三分之一的憩室病患者会出现反复发作的腹痛，尤其是那些以前有过急性憩室炎发作的患者。目前对这种疼痛的病因知之甚少。我们的目的是评估憩室病患者的内脏敏感性及其与以前炎症和神经肽标志物的关系。
无症状和有症状的憩室病患者接受了乙状结肠镜检查和活检，5-10 天后，使用直肠扩张的压力计进行内脏敏感性测试。通过对 5-羟色胺 (5HT) 和 CD3 阳性细胞染色评估炎症。使用 RT-PCR 定量肿瘤坏死因子-α (TNF-α) 和白细胞介素-6 (IL-6) 的 mRNA 水平。通过物质 P (SP) 的百分比面积染色和神经激肽 1 和 2 受体 (NK1 和 NK2) 及甘丙肽 1 受体 (GALR1) 的 mRNA 水平评估神经肽表达。
招募了 13 名无症状和 12 名有症状的患者。有症状的患者首次报告疼痛的阈值较低 (28.4mmHg，IQR 25.0-36.0) ，而无症状的患者为 47mmHg，IQR 36.0-52.5，P<0.001)。有症状的患者对刺激的总体疼痛评分中位数高于无症状患者 (P<0.02)。与无症状患者相比，有症状的患者的 NK1 和 TNF-α mRNA 的相对表达中位数更高。压力计 VAS 疼痛评分与 NK1 表达呈显著相关性 (图 4，r²0.54，P<0.02)。
有症状的憩室病患者表现出内脏敏感性，这可能是由持续存在的低度炎症和速激肽的上调介导的。
